Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/373
Title: Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center
Authors: MONTENEGRO, Fabio Luiz de MenezesLOURENCO JUNIOR, Delmar MunizTAVARES, Marcos RobertoARAP, Sergio SamirNASCIMENTO JUNIOR, Climerio PereiraMASSONI NETO, Ledo MazzeiD'ALESSANDRO, AndreTOLEDO, Rodrigo AlmeidaCOUTINHO, Flavia LimaBRANDAO, Lenine GarciaSILVA FILHO, Gilberto de Britto eCORDEIRO, Anoi CastroTOLEDO, Sergio Pereira Almeida
Citation: CLINICS, v.67, suppl.1, p.131-139, 2012
Abstract: Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1.
Appears in Collections:

Artigos e Materiais de Revistas Científicas - FM/MCG
Departamento de Cirurgia - FM/MCG

Artigos e Materiais de Revistas Científicas - FM/MCM
Departamento de Clínica Médica - FM/MCM

Artigos e Materiais de Revistas Científicas - HC/ICESP
Instituto do Câncer do Estado de São Paulo - HC/ICESP

Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - LIM/25
LIM/25 - Laboratório de Endocrinologia Celular e Molecular

Artigos e Materiais de Revistas Científicas - LIM/28
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço


Files in This Item:
File Description SizeFormat 
art_MONTENEGRO_Total_parathyroidectomy_in_a_large_cohort_of_cases_2012.PDFpublishedVersion (English)617.8 kBAdobe PDFThumbnail
View/Open

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.